Department File Number : | M201885460 |
Claim Number : | HOS-MM-160037 |
Date Submitted : | 6/6/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CATLIN SPECIALTY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
71-6053839 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Denise | LaSorte | |||
Street Address | |||||
XL Catlin, 3340 Peachtree Road, NE | |||||
City | State | Zip | |||
Atlanta | GA | 30326 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 443 - 5262 | denise.lasorte@xlcatlin.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | DAVID | S | OWENS | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 200 Oakside Lane, Suite A | ||||
City | State | Zip Code | County | ||
Canton | GA | 30114 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PLM-686731-0716 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME101568 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Clay | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
ORANGE PARK MEDICAL CENTER | 100226 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/16/2015 | 4/4/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pulmonary Embolism | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Delay in diagnosis. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
PE | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/5/2016 | 005164 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 7/31/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/1/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $137,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $73,604 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $137,500 | ||||||||||||||||||||
Deductible | $2,500 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. DAVID S OWENS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID S OWENS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).